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Clinical Features Dermatitis Symmetrical hyperpigmented, scaly rash Exposed areas affected: face, neck (Casal necklace), hands, forearms Worsened by sunlight Glossitis (smooth, red tongue) Gastrointestinal Diarrhea, abdominal pain, vomiting Malabsorption may worsen the condition Neurological / Psychiatric Depression, irritability Memory loss, confusion, dementia Headache Advanced / Untreated Severe malnutrition, weakness Death if untreated 3

"Gila monster"